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Intensive Care for Respiratory Diseases
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Intensive Care for Respiratory Diseases

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Intensive Care".

Deadline for manuscript submissions: 25 October 2024 | Viewed by 15089

Special Issue Editors

Dr. Tamás Dolinay

E-Mail Website
Guest Editor
1. Department of Medicine, University of California, Los Angeles, CA 90095, USA
2. Respiratory Hospital, University of California, Los Angeles, CA 90095, USA
Interests: ICU; critical care; interstitial lung disease; obstructive lung disease; sleep apnea
Dr. Jeffrey A. Haspel

E-Mail Website
Guest Editor
Division of Pulmonary & Critical Care Medicine, Washington University School of Medicine in St. Louis, St. Louis, MO 63110, USA
Interests: authophagy; immunity; asthma

Special Issue Information

Dear Colleagues,

Pulmonary medicine has undergone a tremendous transformation in the past years. One of the drivers of this change is the increased acuity of diseases, making the pulmonologist an indispensable team member in intensive care unit (ICU).  At the same time, the ICU has significantly broadened the scope our practice. In this special issue, we would like to publish articles that examine this new trajectory. We are looking for manuscripts regarding the intensive care of pulmonary infections, chronic lung diseases and lung malignancies. Furthermore we are interested in the experiences of pulmonologist working in intensive care with a non-traditional focus, which can include early diagnostics, research, lung transplantation, chronic mechanical ventilation or end of life care. We hope that this publication collection will inspire the next generation of physicians to consider our field of practice and provide guidance for current trends in pulmonary medicine.

Dr. Tamás Dolinay
Dr. Jeffrey A. Haspel
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • ICU
  • pulmonary infections
  • chronic lung diseases
  • lung transplantation
  • mechanical ventilation
  • end of life care

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Further information on MDPI's Special Issue polices can be found here.

Published Papers (6 papers)

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Research

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14 pages, 1100 KiB  
Article
Low-Frequency Ventilation May Facilitate Weaning in Acute Respiratory Distress Syndrome Treated with Extracorporeal Membrane Oxygenation: A Randomized Controlled Trial
by Martina Hermann, Sebastian König, Daniel Laxar, Christoph Krall, Felix Kraft, Katharina Krenn, Clemens Baumgartner, Verena Tretter, Mathias Maleczek, Alexander Hermann, Melanie Fraunschiel and Roman Ullrich
J. Clin. Med. 2024, 13(17), 5094; https://doi.org/10.3390/jcm13175094 - 27 Aug 2024
Viewed by 541
Abstract
Although extracorporeal membrane ventilation offers the possibility for low-frequency ventilation, protocols commonly used in patients with acute respiratory distress syndrome (ARDS) and treated with extracorporeal membrane oxygenation (ECMO) vary largely. Whether strict adherence to low-frequency ventilation offers benefit on important outcome measures is [...] Read more.
Although extracorporeal membrane ventilation offers the possibility for low-frequency ventilation, protocols commonly used in patients with acute respiratory distress syndrome (ARDS) and treated with extracorporeal membrane oxygenation (ECMO) vary largely. Whether strict adherence to low-frequency ventilation offers benefit on important outcome measures is poorly understood. Background/Objectives: This pilot clinical study investigated the efficacy of low-frequency ventilation on ventilator-free days (VFDs) in patients suffering from ARDS who were treated with ECMO therapy. Methods: In this single-center randomized controlled trial, 44 (70% male) successive ARDS patients treated with ECMO (aged 56 ± 12 years, SAPS III 64 (SD ± 14)) were randomly assigned 1:1 to the control group (conventional ventilation) or the treatment group (low-frequency ventilation during first 72 h on ECMO: respiratory rate 4–5/min; PEEP 14–16 cm H2O; plateau pressure 23–25 cm H2O, tidal volume: <4 mL/kg). The primary endpoint was VFDs at day 28 after starting ECMO treatment. The major secondary endpoint was ICU mortality, 28-day mortality and 90-day mortality. Results: Twenty-three (52%) patients were successfully weaned from ECMO and were discharged from the intensive care unit (ICU). Twelve patients in the treatment group and five patients in the control group showed more than one VFD at day 28 of ECMO treatment. VFDs were 3.0 (SD ± 5.5) days in the control group and 5.4 (SD ± 6) days in the treatment group (p = 0.117). Until day 28 of ECMO initiation, patients in the treatment group could be successfully weaned off of the ventilator more often (OR of 0.164 of 0 VFDs at day 28 after ECMO start; 95% CI 0.036–0.758; p = 0.021). ICU mortality did not differ significantly (36% in treatment group and 59% in control group; p = 0.227). Conclusions: Low-frequency ventilation is comparable to conventional protective ventilation in patients with ARDS who have been treated with ECMO. However, low-frequency ventilation may support weaning from invasive mechanical ventilation in patients suffering from ARDS and treated with ECMO therapy. Full article
(This article belongs to the Special Issue Intensive Care for Respiratory Diseases)
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Review

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15 pages, 2255 KiB  
Review
Extracorporeal Membrane Oxygenation for Respiratory Failure: A Narrative Review
by John C. Grotberg, Daniel Reynolds and Bryan D. Kraft
J. Clin. Med. 2024, 13(13), 3795; https://doi.org/10.3390/jcm13133795 - 28 Jun 2024
Viewed by 2771
Abstract
Extracorporeal membrane oxygenation support for respiratory failure in the intensive care unit continues to have an expanded role in select patients. While acute respiratory distress syndrome remains the most common indication, extracorporeal membrane oxygenation may be used in other causes of refractory hypoxemia [...] Read more.
Extracorporeal membrane oxygenation support for respiratory failure in the intensive care unit continues to have an expanded role in select patients. While acute respiratory distress syndrome remains the most common indication, extracorporeal membrane oxygenation may be used in other causes of refractory hypoxemia and/or hypercapnia. The most common configuration is veno-venous extracorporeal membrane oxygenation; however, in specific cases of refractory hypoxemia or right ventricular failure, some patients may benefit from veno-pulmonary extracorporeal membrane oxygenation or veno-venoarterial extracorporeal membrane oxygenation. Patient selection and extracorporeal circuit management are essential to successful outcomes. This narrative review explores the physiology of extracorporeal membrane oxygenation, indications and contraindications, ventilator management, extracorporeal circuit management, troubleshooting hypoxemia, complications, and extracorporeal membrane oxygenation weaning in patients with respiratory failure. As the footprint of extracorporeal membrane oxygenation continues to expand, it is essential that clinicians understand the underlying physiology and management of these complex patients. Full article
(This article belongs to the Special Issue Intensive Care for Respiratory Diseases)
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14 pages, 528 KiB  
Review
Ventilator Weaning in Prolonged Mechanical Ventilation—A Narrative Review
by Tamás Dolinay, Lillian Hsu, Abigail Maller, Brandon Corbett Walsh, Attila Szűcs, Jih-Shuin Jerng and Dale Jun
J. Clin. Med. 2024, 13(7), 1909; https://doi.org/10.3390/jcm13071909 - 26 Mar 2024
Cited by 1 | Viewed by 4448
Abstract
Patients requiring mechanical ventilation (MV) beyond 21 days, usually referred to as prolonged MV, represent a unique group with significant medical needs and a generally poor prognosis. Research suggests that approximately 10% of all MV patients will need prolonged ventilatory care, and that [...] Read more.
Patients requiring mechanical ventilation (MV) beyond 21 days, usually referred to as prolonged MV, represent a unique group with significant medical needs and a generally poor prognosis. Research suggests that approximately 10% of all MV patients will need prolonged ventilatory care, and that number will continue to rise. Although we have extensive knowledge of MV in the acute care setting, less is known about care in the post-ICU setting. More than 50% of patients who were deemed unweanable in the ICU will be liberated from MV in the post-acute setting. Prolonged MV also presents a challenge in care for medically complex, elderly, socioeconomically disadvantaged and marginalized individuals, usually at the end of their life. Patients and their families often rely on ventilator weaning facilities and skilled nursing homes for the continuation of care, but home ventilation is becoming more common. The focus of this review is to discuss recent advances in the weaning strategies in prolonged MV, present their outcomes and provide insight into the complexity of care. Full article
(This article belongs to the Special Issue Intensive Care for Respiratory Diseases)
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14 pages, 292 KiB  
Review
Approach to Decompensated Right Heart Failure in the Acute Setting
by Catherine V. Levitt, Caitlin A. Williams, Jalil Ahari and Ali Pourmand
J. Clin. Med. 2024, 13(3), 869; https://doi.org/10.3390/jcm13030869 - 2 Feb 2024
Cited by 3 | Viewed by 5990
Abstract
Acute right heart failure (ARHF) arises when the right ventricle fails to pump blood efficiently to the pulmonary circulation. This inefficiency leads to a decreased blood supply to various organs. ARHF is a significant health concern, often leading to increased hospital admissions and [...] Read more.
Acute right heart failure (ARHF) arises when the right ventricle fails to pump blood efficiently to the pulmonary circulation. This inefficiency leads to a decreased blood supply to various organs. ARHF is a significant health concern, often leading to increased hospital admissions and being associated with a higher risk of mortality. This condition underscores the importance of effective cardiac care and timely intervention to manage its complications and improve patient outcomes. Diagnosing ARHF involves a comprehensive approach that includes a physical examination to evaluate the patient’s fluid status and heart-lung function, blood tests to identify potential triggers and help forecast patient outcomes and various imaging techniques. These imaging techniques include electrocardiograms, point-of-care ultrasounds, computed tomography, cardiac magnetic resonance imaging, and other advanced monitoring methods. These diagnostic tools collectively aid in a detailed assessment of the patient’s cardiac and pulmonary health, essential for effective management of ARHF. The management of ARHF focuses on addressing the underlying causes, regulating fluid balance, and enhancing cardiac function through pharmacological treatments or mechanical support aimed at boosting right heart performance. This management strategy includes the use of medications that modulate preload, afterload, and inotropy; vasopressors; anti-arrhythmic drugs; ensuring proper oxygenation and ventilation; and the utilization of heart and lung assist devices as a bridge to potential transplantation. This review article is dedicated to exploring the pathophysiology of ARHF, examining its associated morbidity and mortality, evaluating the various diagnostic tools available, and discussing the diverse treatment modalities. The article seeks to provide a comprehensive understanding of ARHF, its impact on health, and the current strategies for its management. Full article
(This article belongs to the Special Issue Intensive Care for Respiratory Diseases)

Other

Jump to: Research, Review

2 pages, 165 KiB  
Reply
Reply to Brea et al. Comment on “Levitt et al. Approach to Decompensated Right Heart Failure in the Acute Setting. J. Clin. Med. 2024, 13, 869”
by Catherine V. Levitt, Caitlin A. Williams, Jalil Ahari and Ali Pourmand
J. Clin. Med. 2024, 13(13), 3849; https://doi.org/10.3390/jcm13133849 - 29 Jun 2024
Cited by 1 | Viewed by 402
Abstract
We would like to acknowledge and thank the authors of “Defining the Plethoric IVC” [...] Full article
(This article belongs to the Special Issue Intensive Care for Respiratory Diseases)
2 pages, 156 KiB  
Comment
Comment on Levitt et al. Approach to Decompensated Right Heart Failure in the Acute Setting. J. Clin. Med. 2024, 13, 869
by Carolina Brea, Ellen Freeh and Michael I. Prats
J. Clin. Med. 2024, 13(13), 3848; https://doi.org/10.3390/jcm13133848 - 29 Jun 2024
Cited by 1 | Viewed by 437
Abstract
We read with great interest the article titled “Approach to Decompensated Right Heart Failure in the Acute Setting” [...] Full article
(This article belongs to the Special Issue Intensive Care for Respiratory Diseases)
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Displaying articles 1-6

Planned Papers

The below list represents only planned manuscripts. Some of these manuscripts have not been received by the Editorial Office yet. Papers submitted to MDPI journals are subject to peer-review.

Title: Extracorporeal Membrane Oxygenation for Respiratory Failure: A Narrative Review
Authors: John Grotberg; Bryan D Kraft; Daniel Reynolds
Affiliation: Washington University in St. Louis
Abstract: Extracorporeal membrane oxygenation (ECMO) support for respiratory failure in the intensive care unit continues to have an expanded role in select patients. While acute respiratory distress syndrome remains the most common indication, ECMO may be used in other causes of refractory hypoxemia and/or hypercapnia. The most common configuration is veno-venous (V-V) ECMO, however in specific cases of refractory hypoxemia or right ventricular failure, some patients may benefit from veno-pulmonary (V-P) ECMO or veno-venoarterial (V-VA) ECMO. Patient selection and extracorporeal circuit management are essential to successful outcomes. This narrative review explores the physiology of ECMO, indications and contraindications, ventilator management, extracorporeal circuit management, troubleshooting hypoxemia, complications, and ECMO weaning in patients with respiratory failure. As the footprint of ECMO continues to expand it is essential that clinicians understand the underlying physiology and management of these complex patients.

Title: Critical care approach to Massive Pulmonary Embolism; A Narrative Review
Authors: Pourmand A, Hasan D, Boone K, Miller A, Ahari J
Affiliation: The George Washington University School of Medicine and Health Sciences

Title: Mechanical Ventilation Troubleshooting for acute severe asthma in the acute care setting
Authors: Pourmand A, McLaughlin E, Boone K, Ahari J
Affiliation: The George Washington University School of Medicine and Health Sciences Submission Date: April 7, 2024

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